Mithani Karim, Zhang Kristina, Yan Han, Elkaim Lior, Gariscsak Peter J, Suresh Hrishikesh, Gouveia Flavia Venetucci, Fasano Alfonso, Gorodetsky Carolina, Ibrahim George M
Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.
Institute of Medical Sciences, University of Toronto, Toronto, Canada.
Neuromodulation. 2025 Apr;28(3):373-379. doi: 10.1016/j.neurom.2024.07.009. Epub 2024 Sep 20.
Self-injurious behavior (SIB) can occur in the setting of many neurologic disorders that are amenable to deep brain stimulation (DBS). Although certain brain targets are believed to be particularly effective for SIB, improvements in the primary neurologic condition may also reduce co-occurring SIB. We performed a systematic review and meta-analysis of individual participant data to characterize the effects of DBS across various neurologic disorders and brain targets on comorbid SIB.
A systematic review of all available literature on DBS in treating disorders with co-occurring SIB was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Individual participant data were extracted and standardized mean differences (SMDs) in metrics of SIB severity and/or frequency were calculated for meta-analysis. Demographic variables and adverse events were also collated.
Data from 59 patients, identified from 24 articles, with comorbid SIB who underwent DBS for various indications were extracted. The primary neurologic diagnoses included Tourette syndrome (n = 40), dystonia (n = 7), epilepsy (n = 5), acquired brain injury (n = 3), dyskinesia (n = 2), and obsessive-compulsive disorder (n = 2). Overall, DBS was highly effective in treating comorbid SIB (Mean SMD = -2.4, p < 0.0001) across primary disorders and intracranial targets. Patients with dystonia and DBS targeting the posterior hypothalamus had relatively less success at mitigating comorbid SIB.
In patients with comorbid SIB, DBS to treat the primary neurologic condition may also mitigate SIB. Although several targets are emerging for the treatment of severe SIB, this work suggests that DBS targeting the primary neurologic condition should be first considered in comorbid SIB.
自伤行为（SIB）可发生于许多适合进行脑深部电刺激（DBS）的神经系统疾病中。尽管某些脑靶点被认为对SIB特别有效，但原发性神经系统疾病的改善也可能减少同时出现的SIB。我们对个体参与者数据进行了系统评价和荟萃分析，以描述DBS对各种神经系统疾病和脑靶点合并的SIB的影响。
根据系统评价和荟萃分析的首选报告项目指南，对所有关于DBS治疗合并SIB疾病的现有文献进行系统评价。提取个体参与者数据，并计算SIB严重程度和/或频率指标的标准化平均差（SMD）进行荟萃分析。还整理了人口统计学变量和不良事件。
从24篇文章中确定了59例接受DBS治疗各种适应症的合并SIB患者的数据。原发性神经系统诊断包括图雷特综合征（n = 40）、肌张力障碍（n = 7）、癫痫（n = 5）、获得性脑损伤（n = 3）、运动障碍（n = 2）和强迫症（n = 2）。总体而言，DBS在治疗原发性疾病和颅内靶点合并的SIB方面非常有效（平均SMD = -2.4，p < 0.0001）。肌张力障碍患者和以丘脑后下部为靶点的DBS在减轻合并的SIB方面相对效果较差。
在合并SIB的患者中，通过DBS治疗原发性神经系统疾病也可能减轻SIB。尽管出现了几个治疗严重SIB的靶点，但这项研究表明，在合并SIB的情况下，应首先考虑针对原发性神经系统疾病进行DBS治疗。
